Paracoccidioidomycosis in Brazilian Patients With and Without Human Immunodeficiency Virus Infection

Fabrício Arantes de Almeida Infectious Diseases Unit, Internal Medicine Department, Triângulo Mineiro Federal University, Uberaba, Brazil.

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Fernando Freitas Neves Infectious Diseases Unit, Internal Medicine Department, Triângulo Mineiro Federal University, Uberaba, Brazil.

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Delio Jose Mora Infectious Diseases Unit, Internal Medicine Department, Triângulo Mineiro Federal University, Uberaba, Brazil.

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Tarcisio Albertin Dos Reis Infectious Diseases Unit, Internal Medicine Department, Triângulo Mineiro Federal University, Uberaba, Brazil.

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Diego Moelas Sotini Infectious Diseases Unit, Internal Medicine Department, Triângulo Mineiro Federal University, Uberaba, Brazil.

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Barbara De Melo Ribeiro Infectious Diseases Unit, Internal Medicine Department, Triângulo Mineiro Federal University, Uberaba, Brazil.

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Leonardo Eurípedes Andrade-Silva Infectious Diseases Unit, Internal Medicine Department, Triângulo Mineiro Federal University, Uberaba, Brazil.

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Gabriel Nogueira Nascentes Federal Institute of Triângulo Mineiro, Uberaba, Brazil.

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Kennio Ferreira-Paim Infectious Diseases Unit, Internal Medicine Department, Triângulo Mineiro Federal University, Uberaba, Brazil.

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Mario León Silva-Vergara Infectious Diseases Unit, Internal Medicine Department, Triângulo Mineiro Federal University, Uberaba, Brazil.

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Paracoccidioidomycosis (PCM) is endemic to Latin America, where 10 million people may be infected with Paracoccidioides brasiliensis/Paracoccidioides lutzii and 1,600,000 individuals live with human immunodeficiency virus (HIV) infection. An epidemiological overlapping of these infections occurred early in acquired immunodeficiency syndrome era with nearly 180 published cases. This study presents epidemiological, clinical, and outcome profiles for 31 PCM patients with HIV infection diagnosed in a teaching hospital in Brazil, and includes an update of previously reported cases. Medical records were reviewed and data compared with 64 PCM patients without HIV infection. Of the 31 PCM patients with HIV infection, 23 (74.1%) were male, with a median age of 36.7 years, whereas of the 64 PCM, 45 (70.3%) were male, with a median age of 35.1 years. Both groups presented similar proportions for smoking and alcoholism. PCM patients with HIV infection presented more fever, weight loss, and the acute clinical form than the PCM patients who had more mucosal and respiratory involvement characterizing the chronic form. Most PCM patients with HIV infection exhibited overlapping symptoms from both clinical forms with median symptom duration of 4.5 months compared with 8.3 months for the PCM control. Patients received sulfonamides and/or itraconazole for a median of 15.7 and 16.7 months for PCM/HIV-infected and PCM, respectively. Relapses occurred more in PCM (12 [30%]) than PCM/HIV-infected (4 [14.8%]) patients, whose mortality rate was higher (10 [32.8%]) than PCM patients (8 [20%]). The cases of PCM/HIV infection confirm that HIV can interact with some endemic diseases without increasing their frequency, while changing their natural history, clinical presentation, and outcome. The data presented here are in agreement with those observed in other studies.

Author Notes

* Address correspondence to Mario León Silva-Vergara, Medicina Tropical, Universidade Federal do Triângulo Mineiro, Caixa Postal 118, CEP: 38001-970, Uberaba, Minas Gerais, Brazil. E-mail: marioleon.dip@mednet.com.br

Financial support: This study was funded by CNPq grant 470224/2012-6 and FAPEMIG grant APQ 01624-12.

Authors' addresses: Fabrício Arantes de Almeida, Fernando Freitas Neves, Delio Jose Mora, Tarcisio Albertin Dos Reis, Diego Moelas Sotini, Barbara de Melo Ribeiro, Leonardo Eurípedes Andrade-Silva, Kennio Ferreira-Paim, and Mario León Silva-Vergara, Infectious Diseases Unit, Triângulo Mineiro Federal University, Uberaba, Brazil, E-mails: fabricioarantes1988@gmail.com, fernando.neves.f@gmail.com, delioj@gmail.com, tarcisioar@hotmail.com, diegosotini@hotmail.com, secretariadip@dcm.uftm.edu.br, leonardoeuripedes@gmail.com, kenniopaim@gmail.com, and marioleon.dip@mednet.com.br. Gabriel Nogueira Nascentes, Federal Institute of Triângulo Mineiro, Uberaba, Brazil, E-mail: gabrielnog@yahoo.com.br.

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